<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name" class="form-control" name="row[name]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Source')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-source" class="form-control" name="row[source]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Mobile')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-mobile" class="form-control" name="row[mobile]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Wx')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-wx" class="form-control" name="row[wx]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Sex')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-sex" class="form-control" name="row[sex]" type="text" value="">
        </div>
    </div>
  
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('意向程度')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-intention" class="form-control" name="row[intention]" type="text">
        </div>
    </div>
<!-- 
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Channel')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-channel" class="form-control" name="row[channel]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Claim')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-claim" class="form-control" name="row[claim]" type="number">
        </div>
    </div> -->
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
